Provider Demographics
NPI:1598420762
Name:EMBRACE PEDIATRIC HOME CARE LLC
Entity Type:Organization
Organization Name:EMBRACE PEDIATRIC HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-355-7810
Mailing Address - Street 1:2031 4TH ST N STE 3
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4365
Mailing Address - Country:US
Mailing Address - Phone:813-355-7810
Mailing Address - Fax:
Practice Address - Street 1:2031 4TH ST N STE 3
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4365
Practice Address - Country:US
Practice Address - Phone:813-355-7810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health